One in five patients who undergo one of the most popular weight-loss surgical procedures is likely to develop problems with alcohol, with symptoms sometimes not appearing until years after their surgery, according to one of the largest, longest-running studies of adults who got weight-loss surgery.

The finding -- reported online today in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery -- indicates that bariatric surgery patients should receive long-term clinical follow-up to monitor for and treat alcohol use disorder, which includes alcohol abuse and dependence.

"We knew there was an increase in the number of people experiencing problems with alcohol within the first two years of surgery, but we didn't expect the number of affected patients to continue to grow throughout seven years of follow-up," said lead author Wendy C. King, Ph.D., associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. She and her team discovered that 20.8 percent of participants developed symptoms of alcohol use disorder within five years of Roux-en-Y gastric bypass (RYGB). In contrast, only 11.3 percent of patients who underwent gastric banding reported problem alcohol use.

Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States.

RYGB, a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine, was the most popular procedure, with 1,481 participants receiving it. The majority of the remaining participants, 522 people, had a less invasive procedure -- laparoscopic adjustable gastric banding -- where the surgeon inserts an adjustable band around the patient's stomach, lessening the amount of food the stomach can hold. That procedure has become less popular in recent years because it doesn't result in as much weight loss as RYGB.

Both groups of patients increased their alcohol consumption over the seven years of the study; however, there was only an increase in the prevalence of alcohol use disorder symptoms, as measured by the Alcohol Use Disorders Identification Test, following RYGB. Among patients without alcohol problems in the year prior to surgery, RYGB patients had more than double the risk of developing alcohol problems over seven years compared to those who had gastric banding.

"Because alcohol problems may not appear for several years, it is important that doctors routinely ask patients with a history of bariatric surgery about their alcohol consumption and whether they are experiencing symptoms of alcohol use disorder, and are prepared to refer them to treatment," said King.

The American Society for Metabolic and Bariatric Surgery currently recommends that patients be screened for alcohol use disorder before surgery and be made aware of the risk of developing the disorder after surgery. Additionally, the society recommends that high-risk groups be advised to eliminate alcohol consumption following RYGB. However, given the data, King suggests that those who undergo RYGB are a high-risk group, due to the surgery alone.

The LABS-2 study was not designed to determine the reason for the difference in risk of alcohol use disorder between surgical procedures, but previous studies indicate that, compared with banding, RYGB is associated with higher and quicker elevation of alcohol in the blood. Additionally, some animal studies suggest that RYGB may increases alcohol reward sensitivity via changes in genetic expression and the hormone system affecting the areas of the brain associated with reward.

In addition to RYGB, the LABS-2 study identified several personal characteristics that put patients at increased risk for developing problems with alcohol, including being male and younger, and having less of a social support system. Getting divorced, a worsening in mental health post-surgery and increasing alcohol consumption to at least twice a week also were associated with a higher risk of alcohol use disorder symptoms.

King and her team found that although RYGB patients were nearly four times as likely to report having received substance use disorder treatment compared with banding patients, relatively few study participants reported such treatment. Overall, 3.5 percent of RYGB patients reported getting substance use disorder treatment, far less than the 21 percent of patients reporting alcohol problems.

"This indicates that treatment programs are underutilized by bariatric surgery patients with alcohol problems," said King. "That's particularly troubling given the availability of effective treatments."

I am in my third month of sciatica pain, the kind that makes you consider stomach ulcerations by taking All Of The Ibuprofen In The House over the course of the last twelve weeks.

After two or three urgent care appointments and an orthopaedic doctor visit, I saw my primary care doctor and asked her what I could do. I am no longer able to walk normally, lay down or sit. It is a bit ridiculous how stupid this pain is, if I sit (like right his very moment) it takes me quite a long time to get out of this position and fix my hip, leg and back so that I can move at a decent pace. If I stay moving, I'm okay. It is unrealistic to stand and pace every minute of the day so I do get "stuck" like this a few times a day, particularly when this happens:

The primary care physician sent me for an MRI on my lumbar and sacral spine, and it's just a mess. I already knew I had some degeneration, but it's gotten worse and obviously now there's a nerve root issue.

Super! GREAT! Fun! Love it. The problem here is that I want my normal range of motion and movement back (HA HA) and without pain relief that works, this is impossible. Taking NSAIDS after gastric bypass surgery is asking for a bloody ulcerated gut death and I'm currently risking it just to lay down at night.

I am not writing this for pity - there's a million of you out there with similar conditions, and I was told "GO EXERCISE, THAT WILL FIX YOU!" and yes, please, I want to, but HOLY HELL. Exercising by just picking up a toddler's thrown breakfast is like being stabbed in the asscheek. Picking HIM up? YEEEOUCH.

The Doctors welcome Bariatric Surgeon Dr. Frank Chae and his patient Cindy. “I have had an incredibly positive experience with my device,“ says Cindy. After her vBLOC was inserted, she lost 45 pounds in 11 months. Dr. Chae recommends the device for patients who are not only overweight but on verge of type 2 diabetes or suffering from hypertension or disease.

Special Issues for Women After Bariatric Weight-Loss Surgery

Bariatric surgery — operations such as gastric sleeve, gastric band, and Roux-en-Y gastric bypass that change the digestive tract — has enabled many obese people to approach and maintain a healthy weight while controlling life-threatening obesity-related medical conditions like heart disease, sleep apnea, diabetes, and high blood pressure. More than half of those who have benefitted from bariatric surgery are women, mostly in their childbearing years. If you are a woman considering bariatric surgery, you should be aware of some special issues.

Choose and Use an Effective Method of Pregnancy Prevention

It's generally a good idea to avoid pregnancy before most surgeries because of the stress placed on your body and the drugs that may be used during and after the operation. Most medical experts agree that women should delay pregnancy for 1 to 2 years after bariatric surgery. This type of surgery enables you to lose weight by altering your body's ability to absorb the nutrients in food — which also means that, if you get pregnant too soon, the fetus might not get the nutrients it needs to grow and develop normally. Once your nutrition has improved (usually with the help of a specialist such as a dietitian), your body can provide a better environment to support a healthy baby.

Even if you were unable to get pregnant before, you will need an effective method of contraception (pregnancy prevention). Women who are very overweight commonly don't release eggs from their ovaries, don't have regular periods, and have difficulty becoming pregnant. With weight loss after bariatric surgery, your ovaries may begin working normally again, making pregnancy possible.

The Most Effective Methods: IUDs and Implants

Whether you don't want to have children or you need to delay pregnancy for a while after surgery, consider one of the “get it and forget it” methods — the intrauterine device (IUD) or implant. These are the most effective methods available and do not require you to do anything other than decide to use them and have them placed (the IUD goes into the uterus, and the implant is inserted under the skin of the upper arm) by a clinician (doctor, nurse practitioner, nurse midwife, or physician assistant) during an office visit. There are several types of IUDs; the longest lasting can prevent pregnancy for up to 12 years. The implant works for up to 5 years. Either method can be removed in a brief office procedure if you are ready to get pregnant or want to stop using it. Your ability to become pregnant should return quickly.

Hormone-Containing Methods: Pill, Patch, Vaginal Ring, Shot

You can also choose to take a pill daily, use a contraceptive patch weekly, insert a vaginal ring monthly, or get a shot every 3 months. These methods are all considered safe after weight-loss surgery. However, some types of bariatric surgery (such as gastric bypass) may decrease the amount of hormones you can absorb from pills; therefore, pills may not work as well as other methods, and it's reasonable to suggest that you choose this option only if you are unable or unwilling to use other methods. The hormones in the patch are absorbed through the skin, those in the ring are absorbed through vaginal tissue, and those in the shot are absorbed from muscle or tissue under the skin. These methods do not depend on the digestive tract, so bariatric surgery does not affect how well they work. You should be aware, however, that some women gain weight with the shot.

If you are not satisfied with the contraceptive method you have chosen, talk to your clinician about changing methods until you find one you're comfortable with and can use correctly and consistently. If you are having unwanted side effects (such as irregular bleeding or spotting with the IUD or shot), check with your clinician to see if these problems can be controlled. Most side effects improve on their own after a few months of method use.

If You Do Become Pregnant

If you get pregnant within a year or two after bariatric surgery, you should work with a clinician and a nutrition expert to make sure you get proper nutrition. You will probably need to take nutritional supplements to provide the correct amounts of vitamins and minerals to the developing fetus. Regular blood tests to check nutrient levels will likely be recommended throughout the pregnancy.

Keeping Your Bones Healthy

Like all women who lose a large amount of weight, those who lose weight after bariatric surgery are apt to experience bone thinning, possibly causing bones to break easily. Although we generally think of osteoporosis (thinning bones) as something that occurs after menopause, even younger women can experience this problem after bariatric surgery. You will probably be advised to take calcium and vitamin D to help prevent bone loss, and the levels of these nutrients in your blood will be tested regularly. If you are postmenopausal (periods have stopped for at least 1 year), your clinician may recommend a test to check your bones before surgery and at regular intervals thereafter. As to when and how often these tests should be done, your clinician's recommendation should be individualized to you.

In addition to the above measures, if you are a smoker, quitting can help keep your bones healthy while also benefitting your health in other ways. Ask for help with smoking cessation; many effective options are available. Avoid excessive alcohol; you should not have more than 2 alcoholic drinks daily and not more than 7 weekly. Regular exercise also helps maintain bone strength.

In Conclusion

Bariatric surgery has many benefits for obese women who have been unable to lose weight and/or have health conditions caused or worsened by excessive weight. After surgery, delaying pregnancy for 1 to 2 years is advisable; you should choose a contraceptive method that will work for you. In addition, be aware that changes in how you absorb vitamins and minerals after surgery may make osteoporosis a possibility. Work with your bariatric surgery team on measures to protect your bone health.

“Bariatric surgery is probably the most effective intervention we have in health care,” says Laurie K. Twells, a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weight-loss surgery’s ability to reverse the often devastating effects of being extremely overweight on health and quality of life.

“I haven’t come across a patient yet who wouldn’t recommend it,” Dr. Twells said in an interview. “Most say they wish they’d done it 10 years sooner.” She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying — and failing — to lose weight and keep it off. And the reason is not a lack of willpower.

“These patients have lost hundreds of pounds over and over again,” Dr. Twells said. “The weight that it takes them one year to lose is typically back in two months,” often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate, an effect not seen after bariatric surgery, which permanently changes the contours of the digestive tract.

In reviewing studies that followed patients for five to 25 years after weight-loss surgery, Dr. Twells and colleagues found major long-lasting benefits to the patients’ health and quality of life. Matched with comparable patients who did not have surgery, those who did fared much better physically, emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety, among other factors that can compromise well-being.

Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar, blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type 2 diabetes, it nearly always puts the disease into remission and slows or prevents the life-threatening damage it can cause to the heart and blood vessels.

Even in the small percentage of patients who ultimately lose little weight after surgery, significant metabolic benefits persist, according to findings at the Cleveland Clinic. In a study of 31 obese diabetic patients who had not lost a lot of excess weight five to nine years after surgery, a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities, Dr. Stacy Brethauer and colleagues reported.

For the two most popular surgical techniques — the gastric bypass and the gastric sleeve — “the metabolic benefits are independent of weight loss,” Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However, the gastric band procedure, which is reversible, lacks these benefits unless patients achieve and maintain significant weight loss, he said.

Experts in the field regard the reluctance of some medical insurers, including Medicaid programs in many states, to cover the cost of bariatric surgery as a penny-wise, pound-foolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical $30,000 price tag of bariatric surgery — sometimes even millions of dollars more.

Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially, the latest long-term research has shown otherwise. In a decade-long follow-up of 1,787 veterans who underwent gastric bypass, a mere 3.4 percent returned to within 5 percent of their initial weight 10 years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of 82 percent of gastric bypass patients, a task too challenging for most clinics.

The study, by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery, found that 10 years later, more than 70 percent of surgical patients lost more than 20 percent of their starting weight, and about 40 percent had lost more than 30 percent. Gastric bypass, an operation called Roux-en-Y, resulted in a somewhat greater weight loss at 10 years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band (Lap-Band) surgery, which “has fallen out of favor in the last two or three years,” Dr. Maciejewski said.

Bariatric surgery, regardless of the method used, is also much safer nowadays than it was even a decade ago, said Dr. Jon C. Gould, a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary on the V.A. study. However, he noted, the surgery is “vastly underutilized,” to the detriment of patients’ health and the nation’s health care costs.

“Less than 1 percent who would qualify for bariatric surgery are actually getting it,” Dr. Gould said. “Although the vast majority have health coverage, insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesity-related health conditions and are taking a slew of medications to control them.”

For example, he said, to be covered for bariatric surgery, Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure.

He cited a further deterrent to bariatric surgery: “a perception that it’s dangerous and doesn’t work,” beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions.

Given the well-documented safety and effectiveness of bariatric surgery, it is now increasingly being performed in people whose obesity is less severe — those with a body mass index (B.M.I.) of 35 or perhaps even less — but who have a metabolic disorder like Type 2 diabetes related to their weight.

In recent years, the profession has promoted what Dr. Gould calls “centers of excellence,” where 100 or more bariatric operations are usually done in a year. Practitioners at these centers “learn from experience, share their knowledge and push for quality improvements,” he said.

Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery, which have combined forces to promote quality control.

While experts agree that money would be better spent on prevention than treatment, Dr. Twells pointed out that “we have yet to find a way to prevent obesity, and people whose health is compromised by their weight deserve to be treated by the most effective method we have.”

These little fruity-chew-Starburst-esque bites have nearly all the multivitamins a bariatric patient needs, in two chews. They ARE Starburst-esque. You unwrap a little square of fruit "candy" out of shiny foil wrapper, and it's reminiscent of candy, just slightly. The taste is at first, berry, then watermelon. There is a slight touch of vitamin, but not much as it's masked greatly by the fruit flavorings. The taste profiles have improved a lot in the last few years.

Check it out:

Multi Chewy Bites have been formulated to deliver a spectrum of essential nutrients to help address nutrient deficiencies common with pre- and post-surgery bariatric patients.* Available in two great flavors: Dark Cherry and Strawberry Watermelon. Individually wrapped in 60-count bags.

Key Features:

Delivers 200% or more of the daily value on 16 key nutrients including:

If you have been following me since Ye Olden Days Of WLS (I had roux en y gastric bypass in 2004, and I've blogged and been on social media since 2005), you will know this is my second go 'round with this product. (Or here is to hoping it is the same product I adored back in days of old.)

Proti Wafers. I think I called them "Sugar Wafers, Only Better" in my very first review which I can no longer find.

In each box, you receive five packs of two wafer-bars. Each packet contains two wafers.

The best way to describe these bars: old-fashioned sugar wafers. I can't think of anything else when biting into them. Except these have a chocolate base, and a chocolate drizzle, dressed much fancier than the stacks of sugar-cookies I ate as a kid.

The biggest difference? These pack 15 grams of protein per 200 calorie serving. That's pretty super for a snack food. Early in my weight loss surgery life, I will admit to being psychotically wary of the carbohydrate, fat and sugar content of this product, but now, I find it is a great balance.

Pros - OMG SUGAR WAFER COOKIES WITH PROTEIN POWERS. Portable protein for the purse (or other) sneaky snacks for the movies. Tastes like it should not be a protein product

Cons - Tastes like it should not be a protein product. Your kids will open them before you get a chance to review them for your blog and ruin the box they came in. Just saying. Your kids will eat them. If you want to save them for your bariatric diet, HIDE THEM from your family because they ain't cheap.

I am remaining in the 170 - 173 pound spot. Obviously, this calorie range keeps me squarely in this weight range. (I have been here for a year and a half?)

I go from 170 to 175. I get excited to see 1-6-9, and then, poof, right back into 170's. I have always shared (in my BBGC support group) that I believe in 10 - 12 calories per pound maintains my size.

Which also means, if I am EVER going to shake off this excess, I must drop back the calories OR ramp up my daily activity by at least 500 - 700 calories per day.

HUGE APATHETIC SIGH FILLED WITH TOAST. "BUT I DON'T WANNNNNNAAAAAA EAT LESS." I have become way too comfortable with over-eating. I can eat me some 1700 calories with ease. I can polish off a bowl of Anycarbs! like nobodies business. Hand me Anycarbs! (...except cereal and milk, gag) and I'll overeat it for you!

What made me realize this? One of my daughters decided to start looking at portions. She pulled out the measuring cups. And DOG KNOWS I AM A PROFESSIONAL MEASURER OF ALL THINGS NUTRITIVE and I can tell you how many calories are in all the things -- but -- do I bother measuring my own foods?

Nah. scoop scoop scoop

When I looked at her wee bowl of pasta and realized (for the millionth time) that 1/2 cup of pasta is only > this < much? And I have been serving myself with > this < much stomach + THIS MUCH + just because it's there? Thud.

Last night while watching My 600 LB Life -- I noted that Dr. Now puts all the patients on a 1200 calorie diet. It works. What I am doing, is not working. It's maintaining my obesity. What does this mean for me? I am going to make a conscious effort to aim for 1200 calories. I know that my aiming for that I may or may not - but it's not a huge deal. If I can hit it some days, I'll make progress. My goal is 150 pounds, so a loss of 20 pounds. To do that, I'll need to CUT THE CARBS back. I may need to cut out a meal or snack or three. Add shakes in? Maybe. I haven't "dieted" in so very long it's hard to even consider? I see lots of my online friends having great success with super low carb plans, some even KETO, but, I need something that is very flexible - even - ready to go - with no planning. I'm just ... chaotic. But I'll follow anything and be likely to succeed if I can get with it, you know?

Are you following any plans right now? Do you have excess weight to lose?

Girl, what are you thinking? Why are we flopping our fupa all over the Instagram and sharing/errr selling it to The Sun UK? We know that shit is real. (Did she really make a single account for, um, skin?)

For a moment I am tempted to pull out the skin I AM IN -- you know -- IN POST WEIGHT LOSS SOLIDARITY, after losing 170 pounds and having two babies and start a fupa social media campaign.

But, uh, no. It's very, very real. We are quite aware. You don't have to flop it on Insta to prove it to any-one.

I signed on with a company to do a monthly product review of bariatric-approved products. My first product arrived this weekend, and in the spirit of full disclosure before I even start the review I have to tell you (...before I laugh, cry, or other?) that I hand-picked the first product because I know I like it. It's something I used to promote back in The Day of Blogging. (I do not know when the day ended, but it's no longer that day.)

The reason I am oversharing with you -- is because -- when I sniffed around the blog to find the first post about said product and it was written or even re-written MORE THAN EIGHT YEARS AGO. Guys. This means I could have written about this item nine or ten years ago and I am about to throw it back in your faces because I am:

Old As Hell (Did you figure out how long has been? Because I just had a minor heart failure.)

Still Around (Sorry?)

Crazy (...to still be around? LOL)

Hungry?

Have Five Kids To Feed And Free Product Sounds Amazing Right About Now

One of the first "rules" (....bahahahaha, rules?) of gastric bypass I learned early on - was not to add concentrated sources of extra calories where they were totally unnecessary. A food that qualifies the unnecessary category for me is - peanut butter and nuts.

I don't like peanut butter, so I was not bothered by not enjoying a peanut butter and jelly sandwich after weight loss surgery.

However, one of the other things you learn later on is YOU NEED EXTRA FAT SOMETIMES. To, uh, make your body work, and to make your skin not fall off. (This is just personal experience. Your mileage may vary. Your body should vary, yadda yadda yadda.) Many of us find that we under-eat fat.

A few weeks ago, I saw in the peanut butter aisle while picking up the nasty creamy gallon jug of peanut butter for my kids, this:

To be fair, I was drawn to it because it read CREAMY and COCONUT. Perhaps I thought it was going to taste of sweet coconut? (I AM A SWEET COCONUT FAN, and I think I might have picked this up thinking it'd be a decadent macaroon-y flavor. Sweet macaroons are asking for sweet death.) Instead, I bought the almond spread -- I made toast. I opened the glass jar, and mixed, it's got a slight oil on top, but nothing like natural peanut butter and it's more creamy like coconut butter - and I smeared it onto my bread. It's a very subtle taste, a teeny bit nutty, lesser sweet, and creamy. Not at all thick like emulsified peanut or other creamy butters.

Made with whole coconut pulp.

MaraNatha All Natural Coconut Almond Butter Creamy. No stir.

Combines the delicious taste of roasted almonds with the unique flavor of coconut into a smooth nut butter to enjoy every day.

Liven up your favorite sandwich, spread on toast, apples, pancakes or add to your favorite hot cereal for a unique meal, or simply enjoy straight from the jar!

It's a delicious treat you can feel good about enjoying each and every day.

Please recycle this container.

Comments or questions?

Call 1-800-749-0730 or visit www.maranathafoods.com.

Warnings:

Ingredients:

I loved it. I ate the whole jar over breakfasts in the next couple of weeks, every single morning. I must have really really liked it. When I returned to the store yesterday, however, I noted that it costs double what the peanut butter cost, at least, and I couldn't justify buying it this week. Maybe next time. (You know, I had to get my bread, which costs way too much. :x ..... )

People like to make fun of first-time parents. They run to the emergency room with their babies littlest concerns. Sometimes that is true. 20 years ago we probably took a baby to the ER for a head bump once or twice for no real cause, and now? Well, look at this poor nose.

Dad came home and realized he needed something outside in the car -- the mailbox -- somewhere. He opened the baby gate, failed to click it shut, and went out the side door, and did not shut that. Someone who now walks Very Fast, followed him while I was five feet away and I did not notice. The baby was in the presence of THREE ADULTS and none of us noticed that he took off after Daddy. He was gone maybe ten seconds, went through the baby gate, down a step and onto the walkway bricks. Boom on the hands and nose.

Someone who now walks Very Fast, followed him while I was five feet away in the kitchen and I did not notice. The baby was in the presence of THREE ADULTS and none of us noticed that he took off after Daddy. He was gone maybe ten seconds, went through the baby gate, down a step and onto the walkway bricks. Boom on the hands and nose. He was fine, a red clown nose, and now a scabby scrape. BUT IT COULD HAVE BEEN AWFUL.

A friend just pointed out weight loss surgery themed subscription box service, you know -- where you sign up to have a selection of samples (I am guessing these are sample sizes based on the photos given on the website that is at the moment very limited...) sent to you each month. For your payment -- a flat-fee of $34.95 -- you are sent 8 - 12 sample-size products for the bariatric patient.

I can see the niche of people who'd want this. Hi.

I was curious enough to throw my email on their mailing list, but I wonder are free samples worth $4 each? Maybe, I suppose if they have been sourced for you and shipped to you? How long of a commitment is this kind of service? I'm not the kind of person that throws out $34.95 for a box of I Don't Know What's Coming in exchange for grocery money -- however -- I could be swayed.

Don't think I am picking on this service just because it's "bariatric" I have no clue who's pimping it -- I say the same thing about the underpanties boxes -- the snack boxes -- all boxes -- I see them as profit machines for the person behind the curtain. :) I would simply like to know WHY it is worth the cost since some of it is free to the consumer already. Show me.

Apparently this concern with gastric bypass patients hasn't been "well-studied."

Hey researchers - PLEASE SEEK OUT PATIENTS WHOM COMPLAIN OF EXACTLY THESE ISSUES FROM DAY ONE.

Because, uh, *putting on my Dr. Google Hat* they're totally normal and expected, or so we thought? Or am I living under a rock where it's that we're not supposed to live with digestive distress most of the time?I suppose this is my bias because I live as a distressed patient, with a distressed patient, and know mostly only distressed patients? And WHAT IS GOING ON WITH THE FOODS LISTED IN THIS STUDY!?

Researchers examined data on 249 extremely obese patients who had what’s known as laparoscopic Roux-en-Y gastric bypass, which reduces the stomach to a small pouch about the size of an egg.

Two years after surgery, these patients had lost about 31 percent of their total body weight on average. But compared to the control group of 295 obese people who didn’t have operations, the gastric bypass patients were far more likely to experience indigestion and an inability to tolerate multiple foods.

“It was already known from previous studies that the Roux-en-Y gastric bypass might aggravate gastrointestinal symptoms after surgery,” said lead study author Dr. Thomas Boerlage of MC Slotervaart in Amsterdam.

Alright guys, who is going to send me this? Can you feed a family of seven in an InstantPot? Tell me more. I need to know all about this thing. These things. All the things. Amazon linkage below will send you to the product page. Comments are entertaining as always.

Worth a read, and worth a watch. This mimics a bit of my experience, my family's experiences, and brings up some (deeper) questions. As someone who's had gastric bypass in 2004, I'm always intrigued at any new science that's discovered about the gut - brain connections.

"Nearly 200,000 Americans have bariatric surgery each year. Yet far more — an estimated 24 million — are heavy enough to qualify for the operation, and many of them are struggling with whether to have such a radical treatment, the only one that leads to profound and lasting weight loss for virtually everyone who has it. Most people believe that the operation simply forces people to eat less by making their stomachs smaller, but scientists have discovered that it actually causes profound changes in patients’ physiology, altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain."

"Obesity and excess weight is an expanding health problem for more than 60 percent of Americans, and a new study by Hugh Waters and Ross DeVol finds that it's a tremendous drain on the U.S. economy as well. The total cost to treat health conditions related to obesity—ranging from diabetes to Alzheimer's—plus obesity's drag on attendance and productivity at work exceeds $1.4 trillion annually. That's more than twice what the U.S. spends on national defense. The total, from 2014 data, was equivalent to 8.2 percent of U.S. GDP, and it exceeds the economies of all but three U.S. states and all but 10 countries. The report also highlights how this public health challenge can best be addressed."

Is obesity something that we should be tackling? My gut (no pun intended) says OMG OF COURSE YES, because we are looking at some very preventable disesases. Those are some cah-razy numbers. However, does the pharmaceutical industry care? I mean: obesity is Big. Money.

We moved house on Halloween, and in the process, my scale lost it's batteries.

I have avoided quite successfully, replacing the batteries to the scale. The scale, with it's cracked plastic face, still weighs and measures quite accurately and is that what I am afraid of? It hasn't been very long since I checked in with that scale. And my eating hasn't changed much at all, as it never does. I eat what doesn't kill me, and occasional OH MY GOD I MIGHT DIE BECAUSE I ATE THAT YOU SHOULD HAVE WARNED ME foods. I have been one of the most boring-est eaters since weight loss surgery you might ever know.

What I do know is that I am in need of clothes, it's nearly winter and I was wearing maternity clothes in a bigger size last year, and I have nothing right now that fits me appropriately and I really did not want to start this season in my kids' hand me downs. I am in that NO YOU CAN'T GAIN ANYMORE range, I know it. I don't need a scale to tell me that I can hold up a pair of size 14 jeans on my regain butt.

Then again, I'm also okay at this size, because it's also where I land every time I just simply eat what I feel like having without drama. Does that make any sense to you? I feel like if I just added exercise to my current-state-of-toast-and-protein, I would trickle back to my tighter self. Honestly, it's the lack of Doing, not the Poor Eating. I am a decent, not super, decent, better than many, eater. A few days a week of moving my ass would really do the trick.

Could someone just sell that as an edible product -- motivation? Because I don't have it. Aside from running a 13 month old up and down stairs, it's just not happening. All the advice in the world, I'll find excuses.